Hockinson Heights Elementary Attestation Form
The safety of our staff, students, and community is our primary concern. To help prevent the spread of Covid-19 and to help reduce the risk of exposure to others, please monitor your student for symptoms and exposure risks related to COVID-19 prior to entering the building. This form should be completed prior to the first of each month. Thank you for your time and cooperation.

In submitting this form, I attest that my child has no symptoms of COVID-19 and has not been in
contact with someone who has COVID-19 symptoms. This form will be kept on file at HHES for the
current month and needs to be re-submitted at the beginning of each month.

If my child does develop symptoms or is exposed to someone who has COVID-19, I will keep him/her home and
contact Hockinson Heights Elementary immediately at (360) 448-6430.
Email address *
Student Name, First/Last *
In what grade is your student? *
Classroom Teacher *
I agree to check my student daily for the follow symptoms and to keep them home if any symptoms are present. I will contact HHES at 360-448-6430 if my child develops any symptoms.
Has your child been in close contact (6 feet) for longer than 15 minutes, of someone who has tested positive for Covid-19 or who has tested for Covid-19 (and are awaiting test results) due to symptoms associated with Covid-19 in the past 14 days? *
Within the past 14 days, has a public health or medical professional told your student or a family member to self-monitor, self-isolate, or self-quarantine because of concerns about COVID 19 infection? *
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